Bei idiopathischer Fazialisparese stellt Prednisolon als Monotherapie innerhalb von
72 Stunden nach Auftreten immer noch den Behandlungsstandard dar, und die Rolle von
Virostatika ist unklar. Ziel dieses Beitrags ist es, das aktuelle Facharztwissen zur
Diagnostik und Therapie der idiopathischen Fazialisparese, inklusive neuester Erkenntnisse
und Kontroversen, zusammenzutragen. Der Schwerpunkt liegt dabei auf der akuten Phase
der Krankheit.
Abstract
The purpose of this review is to report the knowledge for otolaryngologists on standard
of care, latest advances, interesting new findings and controversies about the treatment
of Bellʼs palsy. This review is focusing on the acute phase of the disease. The chronic
phase, with incomplete, incorrect or no recovery of the palsy, is described briefly.
Treatment with prednisolone alone within 72 hours after onset still is the cornerstone
of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough
clinical trials with influence on the treatment standards have been performed. A study
to clarify the role of prednisolone treatment in children is ongoing. Patient-related
outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability
Index are important tools to assess the subjective severity of the disease and psychosocial
impact of Bellʼs palsy next to the motor deficits. Simplified subjective electronic
grading systems like the eFACE and first automated image analysis systems have been
introduced. Studies clarifying the role of antivirals for severe cases are urgently
needed as well as studies on the role of salvage second line therapy after insufficient
response to initial corticosteroid treatment. An international consensus on the outcome
measures in diagnostics and follow-up is also needed.
Schlüsselwörter
Nervus facialis - Elektromyografie - Leitlinie - Glukokortikoide - Synkinesie
Keywords
facial nerve - electromyography - guideline - glucocorticoids - synkinesis
